Affordable Excellence. William A. Haseltine

Medisave and insurance do not cover the costs of consultation alone. Patients generally pay out of pocket if they wish to seek a second opinion.

      Recent guideline changes have reflected the changing demographics of the nation and the changing needs of the populace, as well as voter sentiment. Some examples:

      Women 50 and over may spend up to S

400 from their Medisave for mammogram screening. The usual cost at polyclinics is S

100. However, the test is offered at a subsidized rate of S

50 for citizens and S

75 for permanent residents.⁶ To address the increase in chronic diseases as Singapore's proportion of elderly people grows, a new program helps pay for outpatient treatment of common chronic conditions: diabetes mellitus, hypertension, lipid disorders, stroke, asthma, chronic obstructive pulmonary disorder, schizophrenia, major depression, bipolar disorder, and dementia. The program provides incentives for people to seek structured treatment and management of their chronic diseases at the primary care level, where better disease management can help reduce the need for hospitalization. A S

30 deductible and a co-payment of 15 percent of the total bill still needs to be paid by the individual, but Medisave can be used to pay the remaining balance of the bill. Up to ten family-related accounts can be drawn upon, and the annual withdrawal limit is capped at S

400 per year for each account.⁷

      In Singapore, the birthrate has been well below replacement levels for many years, a matter of great concern for the future of the country. The total fertility rate in 2011 was just over one child per woman. A rate of two children per woman is considered necessary to keep the population at current levels. Rates below two children indicate that the population is decreasing with a growing percentage of older people.⁸ Furthermore, Singaporeans are marrying later, having children later, or choosing to have fewer children.⁹